This is the experimental drug for the fifth deadliest cancer: trials have positive results

One day, almost two years ago, Mireya Soriano completely lost her appetite, and with that, her strength, along with a sharp pain in her right side. With these symptoms, she went to La Paz Hospital in Madrid, where she has lived for more than a decade, and was diagnosed with lung cancer with liver metastases. This came as a huge surprise to her, as she had never smoked.

This 76-year-old Argentine engineer, writer, and journalist embodies a growing phenomenon. Due to global anti-smoking measures, fewer people are smoking, and lung cancer, which accounts for approximately 80% of all cases, is declining among smokers. However, oncologists are seeing a rise in this respiratory cancer in people who have never smoked. This is affecting women more, although it is unclear why.

The doctors explained to Soriano that his tumor was a little-known subtype for which conventional treatments don't usually work well . They recommended he go to the 12 de Octubre Hospital, south of the capital, where a clinical trial had been launched with a new drug that might work.

In November 2023, she was accepted into the trial. She was so weak she could barely walk. She had lost 15 kilos.

A few weeks after starting treatment, Soriano entered a theater in Montevideo, Uruguay, to collect the Morosoli Silver Award for her literary work. “My son was in the audience and shouted, 'Well done, Mom!'” the writer explained to the Spanish newspaper El País.

“Everyone would think it was because of the prize, but it was really because I was able to climb the stairs on my own,” she adds with a laugh. The writer jokes about being a “guinea pig.” She admits she's regained her strength and is returning to a normal life: “I feel like I did when I was healthy.”

Her oncologist, Jon Zugazagoitia, explains that Soriano's response to treatment was particularly good, but not exceptional. Doctors in the clinical trial, conducted in eight countries with 130 patients, detected tumor shrinkage in seven out of ten participants.

The experimental drug the patient is receiving is called zongertinib, and is part of a new generation of targeted therapies against tumors that exhibit certain genetic markers.

In this case, it's a mutation in the HER2 gene, which is present in approximately 3% of lung cancer cases. It may not seem like much, but in a country like Spain alone, with approximately 48 million inhabitants, it affects approximately 900 people each year.

The drug appears to work best in patients like Soriano who have not received other prior treatments, such as chemotherapy or immunotherapy. The treatment is also easy to administer: one pill a day. The results of this preliminary trial were published in the New England Journal of Medicine, one of the most prestigious medical journals in the world.

According to Zugazagoitia, these results are encouraging because until now there have been no effective treatments for this type of lung tumor, which is quite aggressive and in many cases is already detected with metastases to the liver or brain.

Why does this cancer develop? It's still not known exactly. Partly due to genetics, and partly due to exposure to environmental agents such as radon—a toxic gas associated with granite—and air pollution.

In 2023, a study revealed that just three years of breathing polluted air is enough to cause the incidence of lung cancer in non-smokers to skyrocket.

Zugazagoitia recalls that his first experience with this type of tumor was in 2005, when he was still a medical resident. It was then that it was first observed that this cancer subtype presented molecular alterations that could be a target for targeted therapies.

A few years later, the first drug of this type arrived, targeting the EGFR mutation, and then others for ALK. The trial with the new drug showed an average survival of 15 months, although the data could end up being much better. "In the case of treatments targeting ALK, the initial data was similar, and now we're already at five years," explains Zugazagoitia.

Patients who will participate in the final phase of testing for this new drug, developed by Boehringer Ingelheim, will begin this phase in several countries in August or September.

The compound's effectiveness will now be compared with the best available treatments. If the preliminary data are confirmed, zongertinib will join the other already approved targeted cancer drugs that are gaining ground against cancer.

"Currently, half of all patients with non-small cell lung cancer have some molecular alteration that we can treat with targeted therapy. Five years ago, it was only one in ten," says Zugazagoitia, head of the tumor microenvironment and immunotherapy group at the i+12 Research Institute, affiliated with the 12 de Octubre Institute.

The oncologist warns that we must be realistic about the potential of these drugs. Lung tumors remain the leading cause of cancer death worldwide, and the number of cases that are cured is still a minority.

New treatments targeting genetic alterations reduce the size of tumors, including those that metastasize, but they do not eliminate all malignant cells, explains Zugazagoitia.

"Unfortunately, we're not there yet, but we were starting from a much worse situation, one in which we couldn't do anything. While we can't eliminate the disease, it is possible to make it chronic and allow patients like Mireya, who are under treatment, to lead a normal life," he argues.

Mireya Soriano has had her cancer under control for over a year and a half. She has continued to write articles for newspapers such as La Mañana in Uruguay. Last year, she published Desde el Silencio (From the Silence) (Desnivel), the biography of Eduardo Strauch, a survivor of the 1972 Andean plane crash portrayed in films such as The Snow Society. She goes to the hospital every two weeks for tests, so far without incident. She is already writing her new novel, set in 1970s Argentina and titled, for now, With the Favor of Time.